Leaving teeth open for a long period or the “cleaning of canals” are things of the past. Read on to find out what modern endodontic treatments look like today. Endodontics, a specialist sub-field of dentistry, deals with tooth pulp and the tissues surrounding the root of the tooth and demands a high level of professional care. Damaged tooth pulp is often painful and becomes a pressing reason to visit the dentist. The success of the subsequent endodontic treatment is often decisive in whether the tooth survives, has an influence on the planning of prosthetic work, and also has an impact on periodontal disease.
How do problems occur?
Tooth pulp composed of blood vessels and nerves is located inside teeth. Unfortunately, even relatively small changes often lead to irreversible changes, inflammation, and the subsequent necrosis of the tooth pulp. The most frequent cause of this damage is bacterial infections spreading from deep tooth decay, irritated by extensive preservation and desiccation (e.g. when teeth are crowned), injuries to teeth, and others.
What are the symptoms of inflammation?
The most obvious symptom of acute tooth pulp inflammation is sharp pain. It is definitely a mistake to wait to visit the dentist until this pressing reason arises – the life of the tooth at this moment is already lost. The ideal situation is to uncover and treat tooth decay during preventive dental checkups.
The inflammation gradually spreads and causes the necrosis of the entire tooth pulp. The bacteria engulfing the interior of the tooth produce great amounts of toxins, the spread of which causes inflammation of the adjacent bone. Because this entire process needn’t necessarily be painful, it often occurs over an extended period. The result of this chronic inflammation is the “dissolution” of bone, typically in the area of the tip of the root. This space is filled in with connective tissue, a scar known popularly as a “pouch”.
What does endodontic treatment involve?
In all cases the goal of endodontic treatment is
- to remove damaged, infected, or dead tooth pulp;
- to disinfect the inside of the tooth;
- to treat the root canals;
- to fill the root canals with filling material.
In certain situations it may be necessary to perform endodontic treatment on healthy teeth – for prosthetic reasons, for example.
What is the proper course of treatment?
Modern endodontics is an extremely demanding discipline. In addition to extensive equipment, high quality tools and materials, maximum precision is likewise required. More than in any other discipline of dentistry, endodontic work cannot be rushed; for example, treatment of multi-root teeth (molars) can take up to 4 hours.
If an entire root canal is to be treated, it is necessary to determine the length of the root of the given tooth. An X-ray with standard endodontic tools is used for this purpose. When values are difficult to determine it may be necessary to repeat the X-ray process. Another special tool used to measure the length of root canals is an apex locator.
Since the main mission of endodontics is primarily the removal or the prevention of infection to the root system, it is essential during treatment to prevent contamination of the tooth by saliva. For this purpose, an aide known as a “cofferdam” isolates the tooth being treated from the surrounding parts of the mouth.
For the same reason it is important to guard against leaving the tooth “open” whenever possible. While opening the tooth may alleviate pain, the roots become susceptible to infection from saliva, thus increasing the chances that the endodontic treatment could fail.
The actual cleaning of the root canals is performed manually or mechanically. The goal is to expand the canal so that remnants of infected tissue do not remain inside and to create space for the root fill material.
Following the completion of the treatment we take a control X-ray to make sure that the root canals are properly filled. Insufficient root fill permits bacteria to survive inside the crown, which can lead to damage to the surrounding bone and lead to the creation of a “pouch”.
Endodontic treatment, resection, or extraction?
The inflammation of the bone around the crown of the tooth and the creation of a “pouch” were earlier a frequent reason for the resection of the crown of the tooth or even the extraction of the tooth. Today there is no doubt that in the majority of cases there will be complete healing and the elimination of the “pouch” if the cause of the inflammation is removed, i.e. as long as expert endodontic treatment is performed.
Endodontic therapy is a primary treatment that should be performed as a matter of priority. If it is performed correctly there is a good chance that the “pouch” will be permanently healed.
Resection of the root head is a surgical procedure in which the “pouch” itself is removed along with the part of the root head that could not be properly treated through endodontic therapy.
Extraction – the removal of the tooth is the final possibility if all previous attempts to remove the causes of the inflammation have failed. In extremely exceptional cases when the prognosis for the tooth is bad for other reasons, extraction is performed immediately.